Provider Demographics
NPI:1720167752
Name:BLISS, BRANDON KENNETH (DPT)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:KENNETH
Last Name:BLISS
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:9070 W CHEYENNE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-8935
Mailing Address - Country:US
Mailing Address - Phone:702-818-5000
Mailing Address - Fax:702-818-5001
Practice Address - Street 1:3401 N CENTER ST STE 200
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-7499
Practice Address - Country:US
Practice Address - Phone:385-309-1951
Practice Address - Fax:385-248-5690
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3085245-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist